Last week, the Congressional Research Service (CRS) of the Library of Congress submitted a report to Congress providing current information on the J-1 Visa Waiver Program as it relates to foreign physicians. The report was provided as background to members of Congress who are currently considering extending the Conrad 30 J-1 waiver program.

Most foreign medical graduates (FMGs) enter the United States under the J-1 visa program for the purpose of graduate medical training and education.  This program requires that the FMGs must return to their home country for at least two years after completion of his or her training before applying for another nonimmigrant visa or legal permanent resident (LPR) status, except for those granted a waiver of the requirement. Waivers can be requested from any interested government agency (IGA) or state health department that wishes to sponsor an FMG.  In return for sponsorship, the FMG agrees to practice as a primary care physician in a selected medical shortage area for a certain period of time.  In 2002, FMGs accounted for 24.7% of the total practicing physicians and 27.4% of physicians in residency and fellowship programs.  This report focuses on FMGs entering through the J-1 program.

Under current law, a J-1 physician can get a waiver of two-year home residency in the following ways:

§         The waiver is requested by an IGA

§         The FMGs return would cause extreme hardship to a U.S citizen or LPR spouse or child

§         The FMG fears persecution in the home country based on race, religion, or political opinion.

A J-1 waiver is processed by an IGA sending a letter of support  to the Department of State. If the DOS concurs, it will forward its recommendation to U.S. Citizenship and Immigration Services (USCIS) for final approval.  The physician would then be able to obtain status as H-1B professional specialty worker (assuming a visa is available).

The J-1 visa waiver program has gone through considerable change in recent years.  The largest sponsor of J-1 visa waivers, the United States Department of Agriculture (USDA), decided to end its involvement as an IGA, effective February 2002.  In addition, the Department of Health and Human Services (HHS) announced it would assume the USDA’s role as an IGA.  And bills introduced in the 107^th Congress expanded the “Conrad 20” program and renamed it the “Conrad 30” which now increases the number of waivers for participating states from 20 to 30. 

Any federal government agency or state department can act as an IGA.  The main agencies involved in this program are the Department of Veterans Affairs (VA), the Department of Health and Human Services (HHS), the Appalachian Regional Commission (ARC), the Delta Regional Authority (DRA), and the “Conrad 20” (now known as the “Conrad 30”) Program for States. 

The specific requirements for each of the main participating IGAs are:

§         The VA allows facility directors to request waivers in cases where efforts to recruit a qualified U.S. citizen or LPR have failed. 

§         The HHS in the past has been very restrictive in its sponsorship of J-1 waivers because the department saw this program as a way to pass advanced medical knowledge to foreign countries.  As an alternative, the HHS position viewed programs such as the National Health Service Corps be used to fill the lack of medical service.  In June 2003, HHS began sponsoring J-1 waivers, but in September 2003 suspended the program.  After reevaluation, HHS released its new program guidelines, which are more restrictive and have limited the states’ access to physicians.  Analyses of the new HHS program show a reduction in the number of eligible facilities by at least 80%. The agency has adjudicated only 42 cases in the last year (compared to nearly 4,000 cases adjudicated by the USDA’s single administrator during the program’s eight year run).

§         The ARC was established by Congress in 1965 and is a joint federal and state entity set up to ensure that all residents of Appalachia have access to quality, affordable health care.  The governor of the sponsoring state must recommend the J-1 waiver sponsored by the ARC.  The FMG must provide primary care for at least 40 hours a week for three years at a medical shortage Medicare or Medicaid-certified hospital or clinic that also accepts medically indigent patients.  The facility must show good faith effort to recruit an U.S. physician for at least six months prior to applying for a J-1 waiver applicant.  If the physician does not comply with the terms of the waiver and complete three years of practice at the selected facility, he or she must pay the employer $250,000.

§         The USDA became a sponsor in 1994 and ceased its involvement in 2002 citing security matters and the inability to perform acceptable background and site checks. 

§         The “Conrad 20” program was set up by Congress in 1994, and was named after its sponsor Senator Kent Conrad.  In 2001, 45 states and the District of Columbia participated in “Conrad 20” programs.  As stated earlier, the “Conrad 20” program was extended until June 1, 2004 and renamed the “Conrad 30” program.  Current Congressional bills are pending which will extend the current program until June 1, 2009; allow state public health departments to identify shortage areas; and make waiver recipients except from the H-1B cap of 65,000.  Administration of the programs varies by state, and the participants have to meet the state-specified licensing criteria before beginning work.

The report can be found online at http://fpc.state.gov/fpc/c12498.htm .